Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy

2009 ◽  
Vol 3 (5) ◽  
pp. 371-377 ◽  
Author(s):  
Ashish Chugh ◽  
Mazhar Husain ◽  
Rakesh K. Gupta ◽  
Bal K. Ojha ◽  
Anil Chandra ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tuberculous Meningitis ◽  
Functional Assessment ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Case Series ◽  
Third Ventriculostomy ◽  
Duration Of Symptoms ◽  
Cine Mr

Object Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post–tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted. Methods Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases. Results The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant. Conclusions Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of endoscopic treatment. Outcome was poorer in patients who presented with higher stages of illness and in those in whom cisternal exudates were observed intraoperatively.

scholarly journals Opening and closure of intraventricular neuroendoscopic procedures in infants under 1 year of age: institutional technique, case series and review of the literature

2020 ◽  
Vol 37 (1) ◽  
pp. 101-105 ◽  
Author(s):  
M. D. Cearns ◽  
M. Kommer ◽  
A. Amato-Watkins ◽  
E. Campbell ◽  
T. Beez ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Case Series ◽  
Csf Leak ◽  
Third Ventriculostomy ◽  
Retrospective Case ◽  
Infantile Hydrocephalus ◽  
Wound Breakdown ◽  
Csf Leakage ◽  
Clinical Records

Abstract Purpose Intraventricular neuroendoscopic techniques, particularly third ventriculostomy, are employed increasingly in the management of infantile hydrocephalus. However, surgical access to the ventricular cavities is associated with a risk of post-operative cerebrospinal fluid (CSF) leak. Here, we describe a structured, multi-layered approach to wound opening and closure which aims to maximise the natural tissue barriers against CSF leakage. We present a series of patients undergoing this technique and subsequently review the literature regarding opening and closure techniques in paediatric intraventricular neuroendoscopic procedures. Methods We performed a retrospective case series analysis of patients under 1 year of age who underwent intraventricular neuroendoscopic procedures in a single institution over a 5-year period. Patients were identified from an institutional operative database, and operation notes and clinical records were subsequently reviewed. Results 28 patients fulfilled the inclusion criteria for this study. The mean age at operation was 9 weeks. 27 patients underwent endoscopic third ventriculostomy whilst 1 underwent endoscopic septostomy, and all patients underwent our structured, multi-layered opening and closure technique. Follow-up ranged from 4 months to 5 years. There were no cases of post-operative CSF leak, infection or wound breakdown. 12 patients remained shunt-free at the last follow-up, with the remaining 16 requiring shunt insertion for progressive hydrocephalus at a mean of 24 days post-operatively. Conclusion Various methods aiming to prevent post-operative CSF leak have been reported in the literature. We propose that our institutional technique may be of benefit in minimising this risk in infants undergoing endoscopic third ventriculostomy and similar intraventricular neuroendoscopic procedures.

Three-dimensional constructive interference in steady-state magnetic resonance imaging in obstructive hydrocephalus: relevance for endoscopic third ventriculostomy and clinical results

2008 ◽  
Vol 109 (5) ◽  
pp. 931-938 ◽  
Author(s):  
Mathias Kunz ◽  
Gernot Schulte-Altedorneburg ◽  
Eberhard Uhl ◽  
Robert Schmid-Elsaesser ◽  
Karsten Schöller ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Endoscopic Third Ventriculostomy ◽  
Clinical Course ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Third Ventriculostomy ◽  
Constructive Interference ◽  
The Third ◽  
Flow Void

Object Endoscopic third ventriculostomy is the treatment of choice in patients with obstructive hydrocephalus caused by aqueductal stenosis. The authors examined the clinical course and results of surgical treatment for obstructive hydrocephalus with pre- and postoperative refined constructive interference in steady-state (CISS) MR imaging. Methods Forty patients with obstructive hydrocephalus underwent pre- and postoperative 3D-CISS imaging and clinical evaluation. Radiological findings were correlated with intraoperative observations of the thickness and transparency of the floor of the third ventricle and the patient's postoperative clinical course. Results Three-dimensional CISS MR imaging provides precise visualization of the basilar/posterior cerebral artery, its distance to the clivus, the diameter of the foramen of Monro, and the extension of and thickness of the floor of the third ventricle. In 71% of patients a flow void was detectable postoperatively on the ventriculostomy. In this group 81.5% had strong and 14.8% moderate clinical benefit, and 3.7% required secondary shunt placement. In the remaining 29% of the patients without a visible flow void, strong improvement was seen in 54.5%, moderate improvement in 18.2%, and stoma failure occurred in 27.3% (p = 0.094). Radiological measurements of the thickness of the third ventricle floor correlated with intraoperative findings (r = 0.35, p = 0.029). Comparison of outcomes showed a statistically significant tendency for a better outcome in patients with thin and easily perforated third ventricle floors (p = 0.04). Conclusions Endoscopic ventriculostomy in patients with obstructive hydrocephalus is safe and mostly successful, and 3D-CISS MR imaging seems to be a valuable diagnostic method for precisely identifying the anatomy of relevant structures. Furthermore, 3D-CISS MR imaging allows judgment of the thickness of the third ventricle floor and display of the ventriculostomy/flow void, which are predictive for intraoperative course and clinical outcome.

Third ventricular shape: a predictor of endoscopic third ventriculostomy success in pediatric patients

2011 ◽  
Vol 7 (4) ◽  
pp. 389-396 ◽  
Author(s):  
Mansoor Foroughi ◽  
Andrew Wong ◽  
Paul Steinbok ◽  
Ash Singhal ◽  
Michael A. Sargent ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Clinical Success ◽  
Third Ventricle ◽  
Ventricular Volume ◽  
Third Ventriculostomy ◽  
Lamina Terminalis ◽  
The Third ◽  
Interpeduncular Cistern ◽  
Endoscopic Third Ventriculostomy Success

Object The criteria for identifying patients in whom endoscopic third ventriculostomy (ETV) provides control of hydrocephalus remain in evolution. In particular, it is not clear when ETV would be effective if intraventricular obstruction is not found preoperatively. The authors postulated that 1) displacement of the third ventricle floor inferiorly into the interpeduncular cistern and displacement of the lamina terminalis anteriorly into the lamina terminalis cistern could predict clinical success of ETV, and 2) improvement in these displacements would correlate with the success of ETV. Methods Magnetic resonance imaging in 38 consecutive patients treated between 2004 and 2010 was reviewed to assess displacement of the lamina terminalis and third ventricular floor prior to and following ETV. Displacements of the floor and lamina terminalis were judged qualitatively and quantitatively, using a newly created index, the Third Ventricular Morphology Index (TVMI). The association between the aforementioned morphological features and clinical success of ETV was analyzed. Results Ninety-six percent of patients in whom the authors preoperatively observed displacement of the lamina terminalis and the third ventricular floor were successfully treated with ETV. Displacements of the third ventricular floor and lamina terminalis, as judged qualitatively, correlated with the clinical success of ETV. The TVMI correlated with the qualitative assessments of displacement. Postoperative decrease in the TVMI occurred in the majority of successfully treated patients. Changes in third ventricular morphology preceded changes in other measures of third and lateral ventricular volume following ETV. Conclusions Assessment of third ventricular floor and lamina terminalis morphology is useful in predicting clinical success of ETV and in the follow-up in treated patients. The TVMI provided a quantitative assessment of the third ventricular morphology, which may be useful in equivocal cases and in research studies.

Pathophysiology of long-standing overt ventriculomegaly in adults

2000 ◽  
Vol 92 (6) ◽  
pp. 933-940 ◽  
Author(s):  
Shizuo Oi ◽  
Masami Shimoda ◽  
Masayoshi Shibata ◽  
Yumie Honda ◽  
Kouji Togo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Third Ventricle ◽  
Three Dimensional ◽  
Sella Turcica ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Patients Âgés ◽  
Cine Mr ◽  
Programmable Valve ◽  
Fine Print

Object. Long-standing overt ventriculomegaly in adults (LOVA) is a unique form of hydrocephalus that develops during childhood and manifests symptoms during adulthood. The aim of the present study was to analyze the specific pathophysiological characteristics of LOVA.Methods. The specific diagnostic criteria for LOVA include severe ventriculomegaly in adults that is associated with macrocephalus measuring more than two standard deviations in head circumference and/or neuroradiological evidence of a significantly expanded or destroyed sella turcica. Twenty patients who fulfilled these criteria, 14 males and six females, were retrospectively studied. These patients' ages at diagnosis ranged from 15 to 61 years (mean 39.4 years). All had symptoms and/or signs indicating that hydrocephalus first occurred at birth or during infancy in the absence of any known underlying disease. The authors performed a pathophysiological study that included specific variations of magnetic resonance (MR) imaging, such as fluid-attenuated inversion recovery and cardiac-gated cine-mode imaging; intracranial pressure (ICP) monitoring; three-dimensional computerized tomography (CT) scanning; and other techniques.Hydrocephalus was caused by aqueductal stenosis in all patients. Severe ventriculomegaly involving the lateral and third ventricles was associated with a marked expansion or destruction of the sella turcica in 17 cases. Cardiac-gated cine-MR imaging did not reveal any significant movements of cerebrospinal fluid in the aqueduct. Three-dimensional CT ventriculography confirmed that the expanded third ventricle protruded into the sella and, sometimes, extended a diverticulum. Fourteen patients revealed symptoms and signs that indicated increased ICP with prominent pressure waves. Dementia or mental retardation was seen in 11 patients, gait disturbance in 12, and urinary incontinence in eight; all three of these symptoms were observed in seven patients. Thirteen patients experienced visual disturbance. Nine patients underwent ventriculoperitoneal shunt implantation as the initial treatment, leading to postoperative subdural hematoma in all seven cases in which a differential pressure valve was used. Nine patients, three of whom were initially treated by shunt placement, underwent a neuroendoscopic procedure, mainly for third ventriculostomy. Postoperatively, ICP returned to normal, and marked to-and-fro pulsatile movements at the site of ventriculostomy were recognized on cine-MR imaging in patients treated endoscopically. However, the ventriculomegaly was little improved. Consequently, all patients eventually demonstrated improvement in response to either a shunt equipped with a pressure-programmable valve or an endoscopic procedure; however, depression appeared in six patients, who required psychiatric consultation or medication.Conclusions. Such remarkably decreased intracranial compliance but relatively high ICP dynamics are the pathophysiological characteristics of LOVA. The therapeutic regimen should be determined based on the individual's specific pathophysiological makeup.

Long-term operative failure of endoscopic third ventriculostomy in pediatric patients: the role of cine phase-contrast MR imaging

2011 ◽  
Vol 30 (4) ◽  
pp. E1 ◽  
Author(s):  
Roberto Faggin ◽  
Milena Calderone ◽  
Luca Denaro ◽  
Luisa Meneghini ◽  
Domenico d'Avella
Keyword(s):  
Mr Imaging ◽  
Third Ventriculostomy ◽  
Dandy Walker Malformation ◽  
Late Failure ◽  
Cine Mr ◽  
Flow Through ◽  
Walker Malformation ◽  
Cine Phase Contrast

Object Although a rarely reported occurrence, late failure of endoscopic third ventriculostomy (ETV) may occur in children as a result of a variety of factors. Delay in recognition of symptoms can lead to harmful deterioration in the patient's condition. The authors undertook this study to assess the capacity of cine phase-contrast MR imaging to identify late failure in asymptomatic pediatric patients treated with ETV for hydrocephalus. Methods This study was a retrospective evaluation of cases involving patients who underwent ETV between January 1, 1999, and December 31, 2008, at the pediatric neurological surgery service of the University of Padua. Before 2004, patients were routinely followed up with cine MR imaging at 3, 6, and 12 months after ETV. In 2004, a protocol of annual cine MR follow-up was instituted as a result of a case of fatal late failure. The authors evaluated all cases of late failure identified through cine MR imaging and performed a statistical analysis to investigate the relationship between ETV failure and several variables, including the cause of hydrocephalus for which ETV was originally indicated. Results In a series of 84 patients (age range 6 days–16 years), 17 patients had early ETV failure. Of the remaining 67 patients, 5 (7%) were found to have no CSF flow through the fenestration and recurrent ventriculomegaly when assessed with cine MR imaging at 1, 2, 3, 4, and 7 years after ETV. The patient in whom ETV failure was identified 1 year postoperatively had Dandy-Walker malformation. The patients in whom ETV failure was identified 2, 3, and 4 years postoperatively all had undergone ETV for treatment of postinfective hydrocephalus. The patient in whom ETV failure was identified 7 years postoperatively had a cystic arachnopathy in the fourth ventricle after cerebellar astrocytoma removal. Conclusions Patients who undergo ETV for infective hydrocephalus and Dandy-Walker malformation should receive long-term follow-up, because late closure of the stoma may occur progressively and slowly. Intraoperative observation of thickened arachnoid membranes at the level of the interpeduncular cisterns at the first ETV and a progressive decreasing of CSF flow through the stoma on routine cine MR imaging should be considered unfavorable elements entailing a significant risk of deterioration.

scholarly journals Combined microsurgical-endoscopic paramedian supracerebellar-infratentorial approach for resection of a pineal low-grade glioma

2021 ◽  
Vol 5 (1) ◽  
pp. V9
Author(s):  
Juan M. Revuelta Barbero ◽  
Roberto M. Soriano ◽  
Rima S. Rindler ◽  
David P. Bray ◽  
Oswaldo Henriquez ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Total Resection ◽  
Blurred Vision ◽  
History Of ◽  
Supracerebellar Infratentorial Approach

The authors present the case of a 20-year-old male with a history of headaches and blurred vision found to have a pineal mass and chronic hydrocephalus. The patient initially underwent an endoscopic third ventriculostomy and pineal mass biopsy that revealed a low-grade neuroepithelial neoplasm. A microsurgery-endoscope–assisted paramedian supracerebellar-infratentorial approach was chosen and a gross-total resection was achieved. The patient’s postoperative and follow-up course has been unremarkable, with early postoperative imaging demonstrating no residual tumoral mass. The operative video highlights the advantages of endoscopic visualization for deep lesions in the pineal region and posterior third ventricle. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2119.

The role of endoscopic third ventriculostomy in the treatment of hydrocephalus

2013 ◽  
Vol 12 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Timothy W. Vogel ◽  
Biji Bahuleyan ◽  
Shenandoah Robinson ◽  
Alan R. Cohen
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Public Health Problem ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Major Public Health Problem ◽  
Shunt System

Object Hydrocephalus remains a major public health problem. Conventional treatment has relied on extracranial shunting of CSF to another systemic site, but this approach is associated with a high rate of complications. Endoscopic third ventriculostomy (ETV) is a novel treatment for select forms of hydrocephalus that can eliminate the need for implantation of a lifelong ventricular shunt system. However, the indications for ETV are contested and its long-term effectiveness is not well established. Methods The authors selected 100 consecutive patients who underwent ETV for hydrocephalus beginning in 1994. Patients were enrolled and treated at a single institution by a single surgeon. The primary outcome was success of ETV, with success defined as no need for subsequent surgery for hydrocephalus. Results Ninety-five patients satisfied the inclusion criteria. The mean follow-up period was 5.1 years (median 4.7 years) with follow-up data available for as long as 17 years. Patients commonly presented with headache (85%), ataxia (34%), emesis (29%), and changes in vision (27%). The success rate for ETV was 75%. Twenty-one patients (22%) in the series had malfunctioning shunts preoperatively and 13 (62%) were successfully treated with ETV. Preoperative inferior bowing of the third ventricle floor on MRI was significantly associated with ETV success (p < 0.05). Conclusions Endoscopic third ventriculostomy is an effective and durable treatment for select patients with hydrocephalus. When successful, the procedure eliminates the lifelong complications associated with implanted ventricular shunts.

Endoscopic third ventriculostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases

2010 ◽  
Vol 5 (4) ◽  
pp. 392-401 ◽  
Author(s):  
Albert A. Sufianov ◽  
Galina Z. Sufianova ◽  
Iurii A. Iakimov
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Negative Relationship ◽  
Third Ventriculostomy ◽  
Patient Age ◽  
The Third ◽  
Patient Âgé ◽  
Significant Difference ◽  
Effective Procedures

Object The object of this study was to analyze the outcome of endoscopic third ventriculostomy (ETV) in patients under 2 years of age and investigate factors related to ETV success or failure in this patient population. Methods The authors reviewed their experience in using endoscopic third ventriculostomy (ETV) in the treatment of 41 hydrocephalus patients younger than 2 years. The mean duration of follow-up was 45 months. The relationship between ETV efficacy and the following variables was analyzed: cause of hydrocephalus, level of CSF occlusion, primary versus secondary ETV, type of surgical procedure, head circumference, patient age at ETV, patient age at first manifestation of hydrocephalus, and anatomical features of the ventricle. Success of ETV was assessed based on the results of neurological examination and postoperative imaging during the follow-up period. Results The authors performed 32 primary ETVs and 10 secondary ETVs (ETV after hydrocephalus surgery) in 41 patients (a second ETV was performed in 1 patient). The success rates of primary and secondary ETV were 75.8 and 55.6%, respectively (no significant difference, p = 0.15). The ETV was clinically and radiologically successful in 30 (71.4%) of 42 procedures during a mean (± SD) follow-up period of 45.0 ± 4.8 months (range 12–127 months). A negative relationship was found between success of ETV and the thickness of the floor of the third ventricle (the most effective procedures were those in which the floor of the ventricle was thinnest [p < 0.05]). There was a highly significant correlation between ETV success and prolapse of the ventricle floor (p < 0.001). Also, there was an inverse relationship between ventricle floor thickness and the width of the third ventricle (p < 0.005). In our group of patients there was significant correlation between ETV success and patient age at onset of hydrocephalus (the most effective procedures were in patients in whom signs of hydrocephalus first occurred after 1 month of age [p = 0.02]). Conclusions Endoscopic third ventriculostomy was successful in 71.4% of procedures in children younger than 2 years and in 75.0% of procedures in infants. Success of ETV in children younger than 2 years depends not on the age of the patient or cause of hydrocephalus but on the thickness of the floor of the third ventricle and the patient's age at first manifestation of hydrocephalus.

scholarly journals Effectiveness of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus of Different Etiology in Terms of Reduction of Ventricle Diameter

1969 ◽  
Vol 11 (4) ◽  
pp. 185-190
Author(s):  
Hamayun Tahir ◽  
Muhammad Ayaz ◽  
Mumtaz Ali ◽  
Naseer Hassan ◽  
Syed Nasir Shah ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Case Series ◽  
Ventricular Volume ◽  
Third Ventriculostomy ◽  
Endoscopic Techniques ◽  
Case Series Study ◽  
3Rd Ventricle ◽  
The Difference

Background: Endoscopic techniques are now gaining insight into the management of various neurosurgical pathologies,including Endoscopic third ventriculostomy (ETV), which is a well-accepted technique for obstructive hydrocephalus of variousetiologies.Objective: To determine the effectiveness of endoscopic third ventriculostomy in obstructive hydrocephalus in terms of reductionof third ventricle diameter (width).Material and Method: This descriptive case series study was conducted at the Department of Neuro Surgery, Lady ReadingHospital, from January 2019 to December 2020. A total of 195 patients between age 1- 60 years meeting the inclusion criteriaunderwent endoscopic third ventriculostomy by a single expert neurosurgeon. Effectiveness of endoscopic third ventriculostomywas measured to reduce at least 1 mm or more from the baseline third ventricle diameter (width) after two months of surgery.Results: In our study, 127 (65.12%) patients were male, while 68 (34.87%) were Females. Mean, and S.D. forAge was as 30.05Years + 17.46.The Mean Baseline 3rd Ventricle Diameter was 5.218mm +1.1, whereas on 60th postoperative Day Follow Up, themean 3rd Ventricle Diameter was recorded as 4 .35mm +1.25. The difference in means between the two groups was 0.864 (pvalue<0.0001), which is statistically significant. Effectiveness of Endoscopic Third Ventriculostomy was recorded on 105 (53.84%)patients, whereas in 90 (46.15%) patients, Obstructive Hydrocephalus remained unchanged.Conclusion: Calculated volumetric measurements (e.g., width) from C.T. scans after successful third ventriculostomy can displaya demonstrable reduction in ventricular volume and help evaluate patients postoperatively.Keywords: ETV, Hydrocephalus, stereotactic.

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